Active NPI
Zachary Ickes, D.D.S.
- Dentist
- Defiance, OH
National Provider Identifier
1790212504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30.025040
- Practice address
- 1601 N Clinton St
Suite a
Defiance, OH 43512-8551 - Phone
- (419) 956-0926
- NPI assigned
- May 11, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30.025040 | OH | Primary |
Addresses
Primary practice location
1601 N Clinton St
Suite a
Defiance, OH 43512-8551
Mailing address
3915 N Township Road 47
Fostoria, OH 44830-9542
Phone (419) 619-7360
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170810003683 | OH | Order and Referring Only - Dentist | 0345511226 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494460800000",
"number": "1790212504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3915 N TOWNSHIP ROAD 47",
"city": "FOSTORIA",
"state": "OH",
"postal_code": "448309542",
"telephone_number": "419-619-7360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 N CLINTON ST",
"address_2": "SUITE A",
"city": "DEFIANCE",
"state": "OH",
"postal_code": "435128551",
"telephone_number": "419-956-0926"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ICKES",
"first_name": "ZACHARY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-05-11",
"last_updated": "2017-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30.025040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Defiance, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.